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Tanabe Y, Kido T, Kurata A, Uetani T, Fukuyama N, Yokoi T, Nishiyama H, Kido T, Miyagawa M, Mochizuki T. Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia - Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion. Circ J 2016; 80:2506-2512. [PMID: 27795485 DOI: 10.1253/circj.cj-16-0834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Single-phase myocardial computed tomography perfusion (CTP) is useful for detecting myocardial ischemia, but determining the optimal scan time is difficult. The present study evaluated this by analyzing dynamic CTP data.Methods and Results:We retrospectively selected 32 patients, all of whom had undergone stress dynamic CTP and magnetic resonance myocardial perfusion imaging (MR-MPI). Myocardial ischemia was assessed by MR-MPI using the 16-segment model. Whole-heart dynamic CTP data were acquired for 30 consecutive heartbeats without spatial or temporal gaps using a wide-detector CT, and redistributed into 11 series of single-phase CTP acquired from -2 s to 8 s from the time of maximal enhancement (Tmax) in the ascending aorta. Single-phase CTP images were visually assessed at the segment level, and diagnostic performance of single-phase CTP images for detecting myocardial ischemia was compared with dynamic CTP. Of 512 segments, 177 segments (35%) were diagnosed as ischemic by MR-MPI. The diagnostic accuracy of single-phase CTP acquired at 2-6 s from Tmax in the ascending aorta (median 86%, range 84-87%) was comparable to that of dynamic CTP. CONCLUSIONS The optimal scan time for detecting myocardial ischemia with single-phase CTP was at 2-6 s from Tmax in the ascending aorta. (Circ J 2016; 80: 2506-2512).
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Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine
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52
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Coenen A, Lubbers MM, Kurata A, Kono A, Dedic A, Chelu RG, Dijkshoorn ML, Rossi A, van Geuns RJM, Nieman K. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis. Eur Radiol 2016; 27:2309-2316. [PMID: 27704198 PMCID: PMC5408049 DOI: 10.1007/s00330-016-4567-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 12/02/2022]
Abstract
Objectives To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Methods Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Results Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Conclusions Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. Key Points • The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease • Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow • The incremental value of the transmural perfusion ratio is limited
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Affiliation(s)
- Adriaan Coenen
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands. .,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Marisa M Lubbers
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Akira Kurata
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Atsushi Kono
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Admir Dedic
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raluca G Chelu
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marcel L Dijkshoorn
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexia Rossi
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Robert-Jan M van Geuns
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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53
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Caruso D, Eid M, Schoepf UJ, Jin KN, Varga-Szemes A, Tesche C, Mangold S, Spandorfer A, Laghi A, De Cecco CN. Dynamic CT myocardial perfusion imaging. Eur J Radiol 2016; 85:1893-1899. [PMID: 27510361 DOI: 10.1016/j.ejrad.2016.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.
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Affiliation(s)
- Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Marwen Eid
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kwang Nam Jin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Adam Spandorfer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
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54
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CT myocardial perfusion imaging: current status and future directions. Clin Radiol 2016; 71:739-49. [DOI: 10.1016/j.crad.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
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Abstract
PURPOSE OF REVIEW Computed tomography (CT) coronary angiography is a well-validated non-invasive technique for accurate and expedient diagnosis of coronary artery disease (CAD). However, a limitation of coronary CT angiography (CCTA) is its limited capability to identify physiologically significant stenoses, which may eventuate the need for further functional testing. Stress CT myocardial perfusion imaging (CT-MPI) is an emerging technique that has the ability to identify flow-limiting stenoses. RECENT FINDINGS The combination of CCTA coronary and CT-MPI has transformed the modality from a tool to assess anatomy and morphology to a modality capable of simultaneous assessment of coronary stenoses and their physiologic significance. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CT-MPI in comparison to a number of reference standard modalities for CAD diagnosis, including single-photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve testing. SUMMARY While there is still a need for consensus regarding acquisition techniques as well as analysis and interpretation of CT-MPI, with further validation, it is likely to become a powerful adjunctive tool to CCTA in the management of patients with suspected coronary disease.
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Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
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Cardiovascular Imaging: The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:557-70. [PMID: 25985464 DOI: 10.1097/rli.0000000000000164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.
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Bindschadler M, Modgil D, Branch KR, La Riviere PJ, Alessio AM. Evaluation of static and dynamic perfusion cardiac computed tomography for quantitation and classification tasks. J Med Imaging (Bellingham) 2016; 3:024001. [PMID: 27175377 DOI: 10.1117/1.jmi.3.2.024001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
Abstract
Cardiac computed tomography (CT) acquisitions for perfusion assessment can be performed in a dynamic or static mode. Either method may be used for a variety of clinical tasks, including (1) stratifying patients into categories of ischemia and (2) using a quantitative myocardial blood flow (MBF) estimate to evaluate disease severity. In this simulation study, we compare method performance on these classification and quantification tasks for matched radiation dose levels and for different flow states, patient sizes, and injected contrast levels. Under conditions simulated, the dynamic method has low bias in MBF estimates (0 to [Formula: see text]) compared to linearly interpreted static assessment (0.45 to [Formula: see text]), making it more suitable for quantitative estimation. At matched radiation dose levels, receiver operating characteristic analysis demonstrated that the static method, with its high bias but generally lower variance, had superior performance ([Formula: see text]) in stratifying patients, especially for larger patients and lower contrast doses [area under the curve [Formula: see text] to 96 versus 0.86]. We also demonstrate that static assessment with a correctly tuned exponential relationship between the apparent CT number and MBF has superior quantification performance to static assessment with a linear relationship and to dynamic assessment. However, tuning the exponential relationship to the patient and scan characteristics will likely prove challenging. This study demonstrates that the selection and optimization of static or dynamic acquisition modes should depend on the specific clinical task.
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Affiliation(s)
- Michael Bindschadler
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Dimple Modgil
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Kelley R Branch
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Patrick J La Riviere
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Adam M Alessio
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
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Fahmi R, Eck BL, Levi J, Fares A, Dhanantwari A, Vembar M, Bezerra HG, Wilson DL. Quantitative myocardial perfusion imaging in a porcine ischemia model using a prototype spectral detector CT system. Phys Med Biol 2016; 61:2407-31. [PMID: 26943749 PMCID: PMC6953388 DOI: 10.1088/0031-9155/61/6/2407] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We optimized and evaluated dynamic myocardial CT perfusion (CTP) imaging on a prototype spectral detector CT (SDCT) scanner. Simultaneous acquisition of energy sensitive projections on the SDCT system enabled projection-based material decomposition, which typically performs better than image-based decomposition required by some other system designs. In addition to virtual monoenergetic, or keV images, the SDCT provided conventional (kVp) images, allowing us to compare and contrast results. Physical phantom measurements demonstrated linearity of keV images, a requirement for quantitative perfusion. Comparisons of kVp to keV images demonstrated very significant reductions in tell-tale beam hardening (BH) artifacts in both phantom and pig images. In phantom images, consideration of iodine contrast to noise ratio and small residual BH artifacts suggested optimum processing at 70 keV. The processing pipeline for dynamic CTP measurements included 4D image registration, spatio-temporal noise filtering, and model-independent singular value decomposition deconvolution, automatically regularized using the L-curve criterion. In normal pig CTP, 70 keV perfusion estimates were homogeneous throughout the myocardium. At 120 kVp, flow was reduced by more than 20% on the BH-hypo-enhanced myocardium, a range that might falsely indicate actionable ischemia, considering the 0.8 threshold for actionable FFR. With partial occlusion of the left anterior descending (LAD) artery (FFR < 0.8), perfusion defects at 70 keV were correctly identified in the LAD territory. At 120 kVp, BH affected the size and flow in the ischemic area; e.g. with FFR ≈ 0.65, the anterior-to-lateral flow ratio was 0.29 ± 0.01, over-estimating stenosis severity as compared to 0.42 ± 0.01 (p < 0.05) at 70 keV. On the non-ischemic inferior wall (not a LAD territory), the flow ratio was 0.50 ± 0.04 falsely indicating an actionable ischemic condition in a healthy territory. This ratio was 1.00 ± 0.08 at 70 keV. Results suggest that projection-based keV imaging with the SDCT system and proper processing could enable useful myocardial CTP, much improved over conventional CT.
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Affiliation(s)
- Rachid Fahmi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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60
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Taguchi K, Cammin J. A new redundancy weighting scheme for nonstationary data for computed tomography. Med Phys 2016; 42:2659-67. [PMID: 25979064 DOI: 10.1118/1.4915954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The same projection data (or line integrals) are often measured multiple times, e.g., twice from opposite directions during one gantry rotation. The redundant data must be normalized by applying redundancy weighting such as the halfscan algorithm, which assumes that the noise of the data is uniform. This assumption, however, is not correct when a tube current modulation technique is employed. The variance of line integrals, which is inversely related to the tube current, could vary significantly. The purpose of this work is to improve how the projection data are used during analytical reconstruction when the tube current is modulated during the scan. METHODS The authors developed a new redundancy weighting scheme. It not only takes into account the data statistics but also can control how much to weigh the statistics from 100% (αs = 1.0) to 0% (αs = 0.0) by a parameter αs. The proposed weighting scheme reduces to the conventional redundancy weighting scheme when αs = 0.0. The authors evaluated the performance of the proposed scheme using computer simulations targeting at myocardial perfusion CT imaging. The image quality was evaluated in terms of the image noise and halfscan artifacts, and perfusion defect detection performance was evaluated by the positive predictive value (PPV) and the area-under-the-receiver operating characteristic-curve (AUC) value. RESULTS Results showed a tradeoff between the image noise and halfscan artifacts. The normalized noise standard deviation was 1.00 with halfscan, 0.89 with αs = 1.0, 0.97 with αs = 0.5, and 1.20 with αs = 0.0 when projections over one rotation (75% of projections are acquired with full dose, 25% with 1/10 of the full dose) are used. The halfscan artifacts were 13.4 Hounsfield unit (HU) with halfscan, 8.2 HU with αs = 1.0, 4.5 HU with αs = 0.5, and 3.1 HU with αs = 0.0. Both the PPVs and AUCs were improved from the halfscan method: PPV, 69.0%-70.6% vs 58.0%, P < 0.003; AUC, 0.935-0.938 vs 0.908, P < 0.003. CONCLUSIONS The new redundancy weight allows for decreasing the image noise and controlling the tradeoff between the image noise and artifacts.
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Affiliation(s)
- Katsuyuki Taguchi
- Division of Medical Imaging Physics, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Jochen Cammin
- Division of Medical Imaging Physics, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
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Tanabe Y, Kido T, Uetani T, Kurata A, Kono T, Ogimoto A, Miyagawa M, Soma T, Murase K, Iwaki H, Mochizuki T. Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography. Eur Radiol 2016; 26:3790-3801. [DOI: 10.1007/s00330-016-4238-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 12/28/2022]
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Técnica de imagen de perfusión miocárdica con tomografía computarizada de estrés: un nuevo tema en cardiología. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stress Computed Tomography Myocardial Perfusion Imaging: A New Topic in Cardiology. ACTA ACUST UNITED AC 2016; 69:188-200. [PMID: 26774540 DOI: 10.1016/j.rec.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023]
Abstract
Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed.
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Koo HJ, Yang DH, Kim YH, Kang JW, Kang SJ, Kweon J, Kim HJ, Lim TH. CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve. Int J Cardiovasc Imaging 2015; 32 Suppl 1:1-19. [DOI: 10.1007/s10554-015-0825-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
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The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT. Eur J Radiol 2015; 84:2411-20. [DOI: 10.1016/j.ejrad.2014.12.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/21/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
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Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning. Phys Med 2015; 31:702-7. [DOI: 10.1016/j.ejmp.2015.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/07/2015] [Accepted: 05/30/2015] [Indexed: 11/20/2022] Open
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Ziemer BP, Hubbard L, Lipinski J, Molloi S. Dynamic CT perfusion measurement in a cardiac phantom. Int J Cardiovasc Imaging 2015; 31:1451-9. [PMID: 26156231 DOI: 10.1007/s10554-015-0700-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/01/2015] [Indexed: 12/22/2022]
Abstract
Widespread clinical implementation of dynamic CT myocardial perfusion has been hampered by its limited accuracy and high radiation dose. The purpose of this study was to evaluate the accuracy and radiation dose reduction of a dynamic CT myocardial perfusion technique based on first pass analysis (FPA). To test the FPA technique, a pulsatile pump was used to generate known perfusion rates in a range of 0.96-2.49 mL/min/g. All the known perfusion rates were determined using an ultrasonic flow probe and the known mass of the perfusion volume. FPA and maximum slope model (MSM) perfusion rates were measured using volume scans acquired from a 320-slice CT scanner, and then compared to the known perfusion rates. The measured perfusion using FPA (P(FPA)), with two volume scans, and the maximum slope model (P(MSM)) were related to known perfusion (P(K)) by P(FPA) = 0.91P(K) + 0.06 (r = 0.98) and P(MSM) = 0.25P(K) - 0.02 (r = 0.96), respectively. The standard error of estimate for the FPA technique, using two volume scans, and the MSM was 0.14 and 0.30 mL/min/g, respectively. The estimated radiation dose required for the FPA technique with two volume scans and the MSM was 2.6 and 11.7-17.5 mSv, respectively. Therefore, the FPA technique can yield accurate perfusion measurements using as few as two volume scans, corresponding to approximately a factor of four reductions in radiation dose as compared with the currently available MSM. In conclusion, the results of the study indicate that the FPA technique can make accurate dynamic CT perfusion measurements over a range of clinically relevant perfusion rates, while substantially reducing radiation dose, as compared to currently available dynamic CT perfusion techniques.
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Affiliation(s)
- Benjamin P Ziemer
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Logan Hubbard
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Jerry Lipinski
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA.
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Regadenoson-Stress Dynamic Myocardial Perfusion Improves Diagnostic Performance of CT Angiography in Assessment of Intermediate Coronary Artery Stenosis in Asymptomatic Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:105629. [PMID: 26236712 PMCID: PMC4506745 DOI: 10.1155/2015/105629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
The prospective study included 54 asymptomatic high-risk patients who underwent coronary CT angiography (CTA) and regadenoson-induced stress CT perfusion (rsCTP). Diagnostic accuracy of significant stenosis (≥50%) determination was evaluated for CTA alone and CTA + rsCTP in 27 patients referred to ICA due to the positive rsCTP findings. Combined evaluation of CTA + rsCTP had higher diagnostic accuracy over CTA alone (per-segment: specificity 96 versus 68%, p = 0.002; per-vessel: specificity 95 versus 75%, p = 0.012) and high overruling rate of rsCTP was proved in intermediate stenosis (40–70%). Results demonstrate a significant additional value of rsCTP in the assessment of intermediate coronary artery stenosis found with CTA.
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Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion. BIOMED RESEARCH INTERNATIONAL 2015; 2015:412716. [PMID: 26185756 PMCID: PMC4491382 DOI: 10.1155/2015/412716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. METHODS One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory parameters like blood flow, aortic pressure, and heart rate were monitored throughout the experiment. Stenosis was induced in the circumflex artery, controlled by a fractional flow reserve (FFR) pressure wire. CT-derived myocardial perfusion parameters were analysed at FFR of 1 to 0.10/0.0. RESULTS CT images did not show major artefacts due to interference of the model setup. The pacemaker-induced heart rhythm was generally stable at 70 beats per minute. During most of the experiment, blood flow was 0.9-1.0 L/min, and arterial pressure varied between 80 and 95 mm/Hg. Blood flow decreased and arterial pressure increased by approximately 10% after inducing a stenosis with FFR ≤ 0.50. Dynamic perfusion scanning was possible across the range of stenosis grades. Perfusion parameters of circumflex-perfused myocardial segments were affected at increasing stenosis grades. CONCLUSION An adapted Langendorff porcine heart model is feasible in a CT environment. This model provides control over physiological parameters and may allow in-depth validation of quantitative CT perfusion techniques.
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Alexanderson-Rosas E, Guinto-Nishimura GY, Cruz-Mendoza JR, Oropeza-Aguilar M, De La Fuente-Mancera JC, Barrero-Mier AF, Monroy-Gonzalez A, Juarez-Orozco LE, Cano-Zarate R, Meave-Gonzalez A. Current and future trends in multimodality imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:715-31. [PMID: 25912725 DOI: 10.1586/14779072.2015.1039991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.
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Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico
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Cannaò PM, Schoepf UJ, Muscogiuri G, Wichmann JL, Fuller SR, Secchi F, Varga-Szemes A, De Cecco CN. Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. Eur J Radiol 2015; 84:2401-10. [PMID: 25779223 DOI: 10.1016/j.ejrad.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.
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Affiliation(s)
- Paola M Cannaò
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Scuola di Specializzazione di Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Giuseppe Muscogiuri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Julian L Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen R Fuller
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
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Eck BL, Fahmi R, Fuqua C, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9417:94170Z. [PMID: 32210494 PMCID: PMC7093059 DOI: 10.1117/12.2081418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dynamic myocardial CT perfusion (CTP) can provide quantitative functional information for the assessment of coronary artery disease. However, x-ray dose in dynamic CTP is high, typically from 10mSv to >20mSv. We compared the dose reduction potential of advanced iterative reconstruction, Iterative Model Reconstruction (IMR, Philips Healthcare, Cleveland, Ohio) to hybrid iterative reconstruction (iDose4) and filtered back projection (FBP). Dynamic CTP scans were obtained using a porcine model with balloon-induced ischemia in the left anterior descending coronary artery to prescribed fractional flow reserve values. High dose dynamic CTP scans were acquired at 100kVp/100mAs with effective dose of 23mSv. Low dose scans at 75mAs, 50mAs, and 25mAs were simulated by adding x-ray quantum noise and detector electronic noise to the projection space data. Images were reconstructed with FBP, iDose4, and IMR at each dose level. Image quality in static CTP images was assessed by SNR and CNR. Blood flow was obtained using a dynamic CTP analysis pipeline and blood flow image quality was assessed using flow-SNR and flow-CNR. IMR showed highest static image quality according to SNR and CNR. Blood flow in FBP was increasingly over-estimated at reduced dose. Flow was more consistent for iDose4 from 100mAs to 50mAs, but was over-estimated at 25mAs. IMR was most consistent from 100mAs to 25mAs. Static images and flow maps for 100mAs FBP, 50mAs iDose4, and 25mAs IMR showed comparable, clear ischemia, CNR, and flow-CNR values. These results suggest that IMR can enable dynamic CTP at significantly reduced dose, at 5.8mSv or 25% of the comparable 23mSv FBP protocol.
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Affiliation(s)
- Brendan L Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Rachid Fahmi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Christopher Fuqua
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mani Vembar
- Philips Healthcare, Cleveland, OH 44143, USA
| | | | - Hiram G Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
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Noninvasive physiologic assessment of coronary stenoses using cardiac CT. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435737. [PMID: 25685790 PMCID: PMC4320886 DOI: 10.1155/2015/435737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022]
Abstract
Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.
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Abstract
During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.
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Affiliation(s)
- Albert de Roos
- From the Department of Radiology, Leiden University Medical Center, C2-S, Albinusdreef 2, Leiden, South-Holland 2333 ZA, the Netherlands (A.d.R); and Department of Radiology, University of California-San Francisco, San Francisco, Calif (C.B.H.)
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Beyond stenosis detection: computed tomography approaches for determining the functional relevance of coronary artery disease. Radiol Clin North Am 2014; 53:317-34. [PMID: 25726997 DOI: 10.1016/j.rcl.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary computed tomography angiography (CCTA) is an established imaging technique for the noninvasive assessment of coronary arteries. However, CCTA remains a morphologic technique with the same limitations as invasive coronary angiography in evaluating the hemodynamic significance of coronary stenosis. Different computed tomography (CT) techniques for the functional analysis of coronary lesions have recently emerged, including static and dynamic CT myocardial perfusion imaging and CT-based fractional flow reserve and transluminal attenuation gradient methods. These techniques hold promise for achieving a comprehensive appraisal of anatomic and functional aspects of coronary heart disease with a single modality.
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Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow. Invest Radiol 2014; 49:801-7. [DOI: 10.1097/rli.0000000000000087] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Saraste A, Knuuti J. Dynamic perfusion CT: what is normal myocardial blood flow? Eur Heart J Cardiovasc Imaging 2014; 16:288-9. [DOI: 10.1093/ehjci/jeu211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve. J Cardiovasc Comput Tomogr 2014; 8:272-81. [PMID: 25151919 DOI: 10.1016/j.jcct.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/07/2014] [Accepted: 06/13/2014] [Indexed: 01/09/2023]
Abstract
Cardiac CT, specifically coronary CT angiography (CTA), is an established technology which detects anatomically significant coronary artery disease with a high sensitivity and negative predictive value compared with invasive coronary angiography. However, the limited ability of CTA to determine the physiologic significance of intermediate coronary stenoses remains a shortcoming compared with other noninvasive methods such as single-photon emission CT, stress echocardiography, and stress cardiac magnetic resonance. Two methods have been investigated recently: (1) myocardial CT perfusion and (2) fractional flow reserve (FFR) computed from CT (FFRCT). Improving diagnostic accuracy by combining the anatomic aspects of coronary CTA with a physiologic assessment via CT perfusion or FFRCT may reduce the need for additional testing to evaluate for ischemia, reduce downstream costs and risks associated with an invasive procedure, and lead to improved patient outcomes. Given a rapidly expanding body of research in this field, this comparative review summarizes the present literature while contrasting the benefits, limitations, and future directions in myocardial CT perfusion and FFRCT imaging.
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Kikuchi Y, Oyama-Manabe N, Naya M, Manabe O, Tomiyama Y, Sasaki T, Katoh C, Kudo K, Tamaki N, Shirato H. Quantification of myocardial blood flow using dynamic 320-row multi-detector CT as compared with 15O-H2O PET. Eur Radiol 2014; 24:1547-56. [DOI: 10.1007/s00330-014-3164-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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